Degenerative disc disease occurs as part of the normal aging process and its treatment costs run in the many billions of dollars per year. Cervical spondylotic myelopathy (CSM), a form of chronic spinal cord injury, is the most debilitating form of degenerative disc disease, and is the most common acquired cause of spinal cord dysfunction in adults greater than 50 years of age. Both surgical and nonoperative management have been advocated for this condition with varying results, and the optimal treatment strategy is frequently debated. MR spectroscopy (MRS) has become widely accepted as a method to provide pertinent information regarding cellular physiology and integrity in the central nervous system, and is commonly used in the evaluation of disorders affecting the brain. Our laboratory has adapted this technology for spinal applications, and we were the first to describe its use in the evaluation of CSM. We have also been pioneers in the development and implementation of Diffusion Tensor Imaging (DTI) biomarker for evaluating spinal cord microstructure and functional impairment, and have recently adopted these biomarkers to CSM patients. Due to the poor natural history of CSM, inherent risks of treatment, and individual/societal cost associated with this disorder, there is a distinct need to develop more accurate, noninvasive methods to predict lesion severity and potential for neurological recovery following operative intervention. Additionally, in those patients treated nonoperatively, the development of non-invasive modalities to monitor subclinical disease progression is of high priority. Accordingly, we plan to investigate a novel, comprehensive approach to evaluate and treat CSM patients that could potentially have a major impact in our field, and would be easily translatable to widespread clinical application. Using the advanced spinal imaging techniques MRS and DTI, we plan to identify the time course of the relevant biochemical and microstructural changes that occur during the pathogenesis of CSM. These cellular and microstructural alterations will be used as biomarkers to monitor asymptomatic patients for signs of cellular signs of spinal cord injury that are likely to precede neurological deterioration. Lasty, these biomarkers will be investigated to determine if they can be used to predict outcome following surgical intervention.